Do long-term hospitalised patients benefit from discharge into the community?

Objective The study investigated whether long-stay patients would benefit from discharge into the community in Berlin, Germany. Method In a prospective controlled study, all long-term hospitalised psychiatric patients from a defined catchment area were assessed using established standardised instruments. Quality of life, treatment satisfaction, needs and psychopathology were re-assessed in 63 non-discharged patients 1.5 years later, and in 65 resettled patients 1 year after discharge. Results Discharged patients were younger and had spent less time in psychiatric hospitalisation. Whilst patients who remained in hospital care did not show significant changes over time, discharged patients did. Changes in subjective quality of life and total number of needs – but not in psychopathology, unmet needs, and treatment satisfaction – were significantly more favourable in resettled patients as compared to the control group. Conclusion The findings are in line with other studies and suggest that long-stay patients can benefit from discharge into the community, particularly with respect to their quality of life. Positive changes in the process of deinstitutionalisation seem not dependent on the specific national context, and also apply to younger patients who have not yet spent 10 or more years in psychiatric hospitals. Accepted: 16 March 2002     

Do patients with Parkinson's disease benefit from embryonic dopamine cell transplantation?

Embryonic dopamine cell transplants survive in nearly all patients regardless of age and without immunosuppression. Transplants can improve Parkinson "off" symptoms up to the best effects of L-dopa observed preoperatively. They cannot improve the "best on" state. Transplants appear to survive indefinitely. In 10 to 15% of patients, transplants can reproduce the dyskinetic effects of L-dopa even after discontinuing all L-dopa. Neurotransplantation should be tried earlier in the clinical course of Parkinson's to see if earlier intervention can prevent progression of the disease, particularly the dyskinetic responses seen after longterm L-dopa treatment.     

Do patients with large vessel occlusion ischemic stroke harboring prestroke disability benefit from thrombectomy?

Journal of Neurology - Evidence of endovascular treatment (EVT) for acute large vessel occlusion (LVO) ischemic stroke in patients harboring substantial prestroke disability is lacking due to their...     

Can patients with severe traumatic brain injury be trained with cognitive telerehabilitation? An inpatient feasibility and usability study

Traumatic Brain Injury (TBI) is the most common cause of long-term disability and death among young adults. Innovation technology, with regard to telerehabilitation, may be of help in managing these frail patients. The aim of the study is to evaluate whether TBI patients and caregivers are able to properly use a Tele-rehabilitation device during hospitalization. Ten TBI subjects (5 males and 5 females; mean age of 45.7 ± 14.4 years), and their caregivers (6 males and 4 females; mean age of 43.7 ± 13.5 years) were consecutively recruited in this preliminary study. After 3 meetings with the telemedicine operators aimed to provide both patients and caregivers with the basic information for the proper use of the device, patients were submitted to 6 training sessions, provided 3 times per week for two weeks, each session lasting about one hour. The telerehabilitation simulation was carried out using the tele-cockpit station and the VRRS-Tablet, used either in the patient's room or in the institute's Family Room. The motivation during training was positive, as per the Intrinsic Motivation Inventory score: 202.6 for patients and 216 for caregivers. Participants also presented positive usability scores, as per the System Usability Scale score: 68 for patients and 69 for caregivers. Our feasibility and usability study supports the idea that in-patients with severe TBI could benefit from cognitive telerehabilitation performed in the pre-discharge phase, in order to get a higher level of adherence to the home tele-treatment and potentially better outcomes.     

Physical activity counseling in primary care and patient well-being: Do patients benefit?

Background: Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease. Benefits to health-related quality of life (HRQL) and subjective well-being may be as important and take less time to accrue.Purpose:We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial (ACT), both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention.Methods: In ACT, 395 female and 479 male inactive patients ages 35 to 75 years were randomized to one of: physician advice, advice plus behavioral counseling during primary care visits, or advice plus behavioral counseling that also included telephone contact and behavioral classes. Participants were assessed at baseline, 6 months, and 24 months. HRQL was assessed as perceived quality of life, perceived stress, depression, and general health. Satisfaction with function and appearance, self-efficacy, and social support were also assessed.Results: At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms. These results mirrored V0₂max changes observed per group. Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months.Conclusions: Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy.     

Do visuospatial and constructional disturbances differentiate frontal variant of frontotemporal dementia and Alzheimer's disease? An experimental study of a clinical belief

BACKGROUND: In recent years several attempts have been made to distinguish frontotemporal dementia (FTD) from Alzheimer's disease (AD) on neuropsychological grounds; in particular, it has been suggested that FTD patients show spared spatial abilities with respect to AD patients. OBJECTIVE: We aimed at verifying whether patients with the frontal variant of frontotemporal dementia (fv-FTD) and AD patients perform differently on visuospatial and constructional tasks. METHODS: We assessed a wide range of visuospatial abilities and provided a qualitative analysis of constructional performances in 14 fv-FTD patients and 11 AD patients, matched for general cognitive abilities. RESULTS: The two groups of patients achieved similar scores on two copying tasks, presented similar drawing procedures in copying Rey complex figure and made a similar quantitative and qualitative pattern of errors in copying simple geometrical drawings. Moreover, no significant difference was found between fv-FTD and AD patients on a specific battery for visuospatial abilities. CONCLUSIONS: Our data and a review of the literature suggest that basic visuospatial and constructional skills cannot be taken as a reliable diagnostic criterion for distinguishing fv-FTD and AD at a mild to moderate disease stage and that the clinical belief of spared spatial abilities in fv-FTD has to be referred to the lack of topographic disorientation in comparison to AD.     

Do seizures cause irreversible cognitive damage? Evidence from animal studies

Data from experimental models provide evidence that both prolonged and brief seizures can cause irreversible impairment in spatial and emotional learning and memory. Factors related to the severity of the behavioral impairments include genetic background, age at the time of the epileptogenic insult, extent of brain lesion, location of seizure focus, seizure duration, seizure number, brain reserve, and environmental and social living conditions. Further, as in humans, the interval between the last seizure and behavioral testing as well as treatment with antiepileptic drugs can affect the test results.     

When do patients forget their seizures? An electroclinical study

Accurate knowledge of the frequency of epileptic seizures is a precondition for evaluating the efficacy of pharmacotherapy. It is a well-known fact that the information provided by epilepsy patients about the number of seizures they experience is often unreliable. In the present study, we aimed to identify predictors of a higher risk of unrecognized events. Thirty patients who underwent presurgical evaluation in a video/EEG monitoring unit were recruited. As soon as the patient became aware of a seizure, he or she completed a standardized questionnaire on the subjective perception of the seizure, which was then compared with the video/EEG findings. Of the 138 seizures recorded, 49.3% were reliably detected by the patient, whereas 44.2% went unnoticed; the remainder were incompletely or uncertainly perceived. Subjects in whom events occurred during sleep or originated in (or propagated to) the left temporal lobe had a significantly higher percentage of unrecognized events.